BENGALURU — A love command of persistence and legal recourse, a Bengaluru-based lawyer has prevailed in her consumer case, securing ₹4 lakh after her health insurer controversially rejected a legitimate claim. The district consumer court ruled against the insurer’s arbitrary denial, delivering a win that underscores insured patients’ rights under India’s healthcare framework.
Court Denounces “Arbitrary” Rejection of Claim
Advocate Nandita Sharma (name changed), who holds a standard hospitalisation policy, sought coverage for an appendix-related operation performed in January 2025. Despite submitting all required documentation, the insurer initially refused, citing vague “policy exclusions.” The court deemed the refusal “arbitrary” and “deficient in service,” ordering full reimbursement of hospital expenses, plus Rs 20,000 for mental anguish and ₹50,000 legal costs.
The court’s decision came after a thorough review of the policy, hospital records, and applicable clauses. It noted that the insurer failed to present any valid ground to support the denial, and its refusal lacked substantiation. The ruling serves as a reminder that insurers must strictly adhere to policy conditions and cannot unilaterally reject payment without transparency.
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Win Sets Precedent for Policyholders
Experts say this judgment highlights a positive shift in consumer protection, ensuring policyholders in smaller cities can hold insurers accountable. Insurance Ombudsman specialists see the verdict as a precedent encouraging applicants to challenge arbitrary rejections in consumer forums.
The lawyer’s win also underscores the effectiveness of legal channels in health insurance disputes, particularly when handled by informed professionals. The case may encourage others in similar predicaments to assert their rights under the Insurance Regulatory and Development Authority of India (IRDAI) guidelines.
About the Author – Anirudh Mittal is a B.Sc. LL.B. (Hons.) student at National Forensic Sciences University, Gandhinagar, with a keen interest in corporate law and tech-driven legal change